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PubMed2005

Loss of appetite: a poetic exploration of cancer patients' and their carers' experiences.

AIM: To explore the experience of loss of appetite among palliative care cancer patients and their carers supported by a specialist palliative care team in the community. METHOD: Semistructured interviews were conducted with seven palliative care cancer patients and their carers in the community. A poetic transcription of participants' words was made to capture and communicate the essence of each person's experience before the thematic analysis was undertaken. FINDINGS: Six common themes emerged from the data: a fickle phenomenon; the cost of caring; facing uncertainty and death; adaptations; accepting limitations; and what patients want: 'listen to me'. These were illustrated by the poetic transcriptions. CONCLUSION: Meeting the differing needs of palliative care patients with loss of appetite and their carers is challenging. It demands a thorough assessment of symptoms, an understanding of the underlying pathophysiology and of the role food plays in society. An understanding of the experience of loss of appetite is essential to the provision of appropriate care and support to those affected by it. The study demonstrated that, although unusual, poetic transcriptions can be an effective method of presenting data in terms of acceptability to participants and communicating their experience to others.

Adaptation, Psychological↗
PubMed2001

'What do our patients really want from us?': Investigating patients perceptions of the validity of the Chartermark criteria.

BACKGROUND: The 'restructuring' of the NHS over the last decade has demanded a 'market oriented' service more receptive to the needs and priorities of 'clients'receiving health care. These changes have been important to the provision of dental health care in which there has been a similar need to provide increasingly patient and market oriented services. One of the ways in which quality care has been assessed within NHS Trusts is through the national 'Chartermark' award, which identifies national centres of excellence in health care and research. AIM: The aim of this paper is to assess whether patients themselves considered the criteria identified by the Chartermark award important in the provision of good quality dental services METHOD: This is a pilot study consisting of a structured questionnaire conducted face-to-face with a 'convenience' sample of 46 patients. ANALYSIS: Data were inputted into SPSS and thematic analysis was conducted on the data. RESULTS: The Chartermark criteria relevant to patient involvement were divided into four main themes.The findings from this small pilot study suggest that in relation to dental care, although patients are interested in information on standards, performance and complaints, there is considerable disinterest in organisational and financial dimensions.

Awards and Prizes↗
PubMed2003

Educating for rural nursing practice.

BACKGROUND: Rural hospitals in Australia, as in many countries, face challenges in ensuring that appropriate, quality services are provided. AIMS: The overall aim of this study was to explore the issues that impact on the ability of rural hospitals to provide effective health care. METHODS: We used a qualitative descriptive method and purposive sampling, and conducted interviews in hospitals in rural Victoria, Australia. The data collected enabled major issues that impact on hospital service delivery to be identified. Using thematic analysis, global themes were extracted and organized around a thematic network. FINDINGS: The workforce was an important theme. Whilst the impact of medical shortages on hospital function has been considered in other studies, little consideration has been given to the rural nursing workforce. The need to maintain an appropriately educated rural nursing workforce emerged as one of the major issues that impact on rural hospital service delivery. In Australia, there has been a great deal of discussion about the educational preparation required for rural nursing practice, with the emphasis on postgraduate study. However, the majority of rural nurses do not have postgraduate qualifications and face significant barriers in obtaining them. Although the vast majority of literature claims that postgraduate preparation is vital for rural nursing practice, this research suggests that the future rural nursing workforce will be recruited from undergraduate courses in regional universities. However, there is a need to include specific theoretical and operational preparation in undergraduate education, to enable nurses to make the transition to rural practice more readily. CONCLUSIONS: Rural nurses are central to the delivery of health services in rural hospitals. Future rural nursing recruitment and retention hinges on ensuring that they have the confidence, knowledge and skills to deliver safe, appropriate and effective care.

Curriculum↗
PubMed1999

An investigation into the functions of nurses' communication at the inter-shift handover.

AIMS: This study set out to investigate the functions of nurses' communication at the inter-shift handover. BACKGROUND: The inter-shift handover should facilitate continuity in care by transferring patient information between shifts. However, nurses may also use this time for team building. METHODS: An observational study was conducted during six inter-shift handovers occurring on one ward in a general hospital in the UK. The data was transcribed and a thematic analysis applied. FINDINGS: The main themes related to the transfer of patient information and team building, the strongest theme being team building. Nurses were found to communicate goals and values relating to nursing practice so facilitating cohesiveness of the nursing team. CONCLUSIONS: The nursing ritual of inter-shift handover serves the purpose of enhancing a shared value system amongst nurses. It should therefore not be regarded as an outdated means of communication.

Communication↗
PubMed2004

Experiences and understandings of social and emotional distress in the postnatal period among Bangladeshi women living in Tower Hamlets.

OBJECTIVE: The purpose of this study was to explore first-generation Bangladeshi women's understandings and experiences of postnatal distress, and to describe coping strategies during the postnatal period. METHODS: This was a qualitative study using focus groups. Subjects were drawn from three existing community groups in Tower Hamlets, a multiethnic, socially deprived borough in east London. Thematic content analysis was used to explore and present the data. RESULTS: Many women received little practical or emotional support once home from hospital with a new baby, because of the lack of extended family networks; this contrasts with the 40 day rest period common in Bangladesh. These women understood emotional distress as separate from physical symptoms or illness, and recognized that one may influence or cause the other. Distinctive language was used to describe these thoughts and feelings. The roles of health visitors, midwives and GPs were understood solely in terms of physical care. Accordingly, they did not access professionals for emotional or psychological problems. Lack of language support services contributed to the women not seeking help. CONCLUSIONS: Information about services, and professional roles in the postnatal period should be extended to include key family members such as husbands and mothers-in-law. Dialogue with Bangladeshi women may ensure that women understand the extended roles of GPs, health visitors and midwives in providing help for emotional distress, alongside their role in physical health care. More language support and advocacy is needed if women are to access the full range of health services.

Adult↗
PubMedDate not supplied

Parental experience of a pediatric genetic referral.

OBJECTIVE: To describe the experience of parents whose child has been referred for possible genetic diagnosis. STUDY DESIGN AND METHODS: Phenomenology was used to examine the experience of 20 sets of parents. Interviews with parents were conducted on three occasions and the transcripts were subjected to coding and thematic analysis. RESULTS: Four themes were found: (1) impact of the child's condition on the family, (2) parental needs and motivation related to the referral, (3) psychological outcome of the referral for parents, and (4) psychosocial needs of parents in relation to the referral. Parents reported much stress, fear, and anxiety. Parents were motivated to accept the genetics referral to obtain information that could enhance the child's care or education and/or assist the parents to adjust psychologically to the child's condition, but preparatory information about the process of the clinical encounter was lacking. One of the worst stressors for parents was waiting for results. Communication with the professionals while they were waiting would have been helpful to them, as would the support to facilitate acceptance and adjustment to the situation. The impact of the child's condition on the family was powerful, altering the way in which the entire family functioned. Guilt about being the cause of the child's condition was expressed by mothers. CLINICAL IMPLICATIONS: Professional input before, during, and after the genetic referral is needed by families to enable them to access additional information, explanations, and psychological support. Nurses should know where to refer parents for community support groups as well as for professional support.

Adaptation, Psychological↗
PubMed2004

The postmodern heart: war veterans' experiences of invasive cardiac technology.

BACKGROUND: The consequences of war and medical discourse have historical connections to pacemaker technology. Understanding these consequences is important because war veterans, medicine and cardiac technology have a shared history that continues into the present. The incidence of Australian war veterans needing cardiac pacemakers has increased many-fold in recent years, due to advancing age. This need was recognized by the Australian Department of Veteran Affairs and a cardiac programme was established in the veteran hospital that was the setting for this study. AIM: This paper reports on a study aimed at capturing the interest and sensitizing the practice of nurses involved in the care of war veterans and other health care consumers who have been diagnosed as requiring a cardiac pacemaker. The study sought to answer the question, 'How does the war veteran experience his body in relation to invasive cardiac technology?'. METHOD: The research was guided by the principles of interpretive interactionism, and used unstructured interviews with eight male war veterans. The data were collected in 2000. FINDINGS: Thematic and content analysis revealed five themes: emotional knowing; the medical encounter; belief in the myth of miracle; technological constraint; and the altered heart. The findings indicated that the human dimension was characterized by experiences of ambivalence, inner conflict, powerlessness and suffering. CONCLUSION: Nursing is at the interface of science and patient care, and this study contributes to nursing knowledge by focusing on a previously unresearched topic, namely embodied interactions between war veterans and invasive cardiac pacemakers. Within a highly technical area such as cardiology, nurses can still work around the technology and keep patients as their primary focus, thus promoting quality care. A humanistic rather than a technological focus locates nurses between patients and cardiac technology. In this in-between location, nurses are not an extension of cardiac technology but a valuable source of information, education, and counselling.

Adaptation, Psychological↗
PubMed2004

Nurse prescribers' experiences of prescribing.

BACKGROUND: Nurse prescribing has advanced rapidly over the previous decade and is clearly on the agenda for the future. Previous research considers nurse prescribing from the patient's perspective, the medical professions' stance and the legal and ethical implications. However, there is a paucity of literature that explores the experiences of nurse prescribers' within their current role. These experiences need investigating to ensure nurse prescribing is able to advance in ways that provide benefit to nurses and thus provides the impetus for the study. AIM: To explore and review nurse prescribers' experiences of prescribing. DESIGN METHODS: A purposeful sample of seven nurse prescribers currently prescribing within a West Midlands Community Trust underwent minimally structured interviews in this qualitative study. Transcribed interviews were analyzed using thematic analysis. FINDINGS: Four themes were generated from analysis of the interviews, 'patient centred care', 'benefits of nurse prescribing', 'support and role satisfaction' and finally 'prescribing difficulties'. CONCLUSIONS: Nurse prescribers' perceive prescribing as a predominantly positive experience, frequently asserting the advantages that prescribing saves the patient and nurse time, is more convenient for the patient and increases the nurses' autonomy and role satisfaction. However, negative experiences of restrictions to practice as a result of nurse prescribers' formulary limitations and duplication of documentation were also described. RELEVANCE TO CLINICAL PRACTICE: Nurse prescribing is a rapidly evolving area of practice with the potential to advance nursing roles. This research aims to provide an insight into the experiences of current nurse prescribers that may then be disseminated and applied to future practice.

Attitude of Health Personnel↗
PubMed2005

Developing a nursing management degree programme to meet the needs of Irish nurse managers.

BACKGROUND: The study is placed within the context of the Irish health care system, which has undergone tremendous change, at the dawn of the new millennium, in particular from the nursing management and leadership viewpoint. AIM OF THE STUDY: The aim of this study is to explore nurses' expectations of the content and delivery of a nursing management degree programme. METHODS: This is an on-going action research study. Data has been collected using a focus group interview, questionnaire, document analysis and a reflective diary. Data was analysed using thematic analysis and SPSS as appropriate to qualitative and quantitative data respectively. To date two action research cycles are near completion and a total sample of 117 students have taken part in the study. FINDINGS: Nurses commencing the programme were unsure of their education and training needs, as they had not yet taken on board the recommendations of the Irish Commission on Nursing (Government of Ireland 1998). The findings suggest that nurse managers may not know what they need to know in light of the many current changes taking place in the Irish health system. The introduction of personal development planning (PDP) is among new strategies taking place as part of the second action research cycle. PDP can help nurse managers to reflect on their current responsibilities and plan for their future career pathways. CONCLUSIONS: The findings are presented in the context of one institution. Action research, which nests comfortably with certain management styles, has proved suitable as a tool for developing and changing this programme. The need for university teachers to focus on management development skills as well as the transmission of management theory is supported.

Education, Nursing, Baccalaureate↗
PubMed2006

Evaluation of consent for peer physical examination: students reflect on their clinical skills learning experience.

INTRODUCTION: Early clinical skills teaching often requires students to learn through examining one another. This model should acknowledge ethical, practical and individual issues, disclosure and identification of abnormalities. Consent to peer physical examination (PPE) is usually expected rather than discussed and sought. OBJECTIVES: We sought to evaluate a formal written consent process for PPE and to explore students' views of this approach. METHOD: A survey tool was designed and distributed to all years 2 and 3 students in the Auckland University medical programme (2004). Results were analysed using univariate statistics and thematic analysis. RESULTS: The response rate was 57% (146/258). Most students had read the participant information sheet prior to signing, with 78% giving consent. They had not felt coerced and the in-course experience matched the 'promise'. Comments included: PPE gave insights into the 'patient's world', encouraged peer learning and raised some professional issues. More than 95% of students took the examination role at least once (less likely if female, P = 0.002). Some European, Maori and Pacific students never took the role; all Asian students did at least once. Students preferred PPE in groups consisting of 'friends'. The task influenced group composition by sex (P < 0.0001) but not ethnicity. DISCUSSION: Students accept and support a formal consent process. PPE participation rates are similar to predictions. The experience must match the promises made. Formal preparation alone might have produced similar student outcomes. Female students are more selective about tasks undertaken. The influence of ethnicity and the effect on future behaviour and attitudes needs further exploration.

Adolescent↗
PubMed2026

A Systematic Review of Lived Experiences of Receiving a Diagnosis of ADHD in Adulthood.

OBJECTIVE: With rising numbers of adults seeking and receiving ADHD diagnoses, understanding their first-hand experiences of the diagnostic process is key for sensitive support and service design. This systematic review collates, evaluates and synthesises the existing evidence-base on lived experiences of adult ADHD diagnosis. METHOD: Keyword searches of six databases generated 10,357 citations, which were subjected to a systematic screening process that identified 21 relevant studies. Findings were analysed using thematic synthesis. RESULTS: Analysis generated three overarching themes, elaborating how diagnostic experiences are shaped by adults' Relationship with Self, Relationship with Others, and Relationship with Systems. Personally, diagnosis was widely experienced as a pivotal identity event, triggering biographical reflection that could foster greater self-compassion, but also grief, anger and identity confusion. Socially, diagnosis facilitated interpersonal understanding and communication, but also exposed adults to stigma and introduced dilemmas about diagnostic disclosure. Systemically, adults experienced the diagnostic process as beset by barriers and delays, and reported highly variable access to post-diagnosis supports or treatment. CONCLUSION: Results suggest receiving an ADHD diagnosis in adulthood is a complex relational process that can be both validating and destabilising, with variation in experiences resulting from individual biographies, interpersonal resources, stigma climates, and service structures.

Humans↗
PubMed2006

Duty, desire or indifference? A qualitative study of patient decisions about recruitment to an epilepsy treatment trial.

BACKGROUND: Epilepsy is a common neurological condition, in which drugs are the mainstay of treatment and drugs trials are commonplace. Understanding why patients might or might not opt to participate in epilepsy drug trials is therefore of some importance, particularly at a time of rapid drug development and testing; and the findings may also have wider applicability. This study examined the role of patient perceptions in the decision-making process about recruitment to an RCT (the SANAD Trial) that compared different antiepileptic drug treatments for the management of new-onset seizures and epilepsy. METHODS: In-depth interviews with 23 patients recruited from four study centres. All interviews were tape-recorded and transcribed; the transcripts were analysed thematically using a qualitative data analysis package. RESULTS: Of the nineteen informants who agreed to participate in SANAD, none agreed for purely altruistic reasons. The four informants who declined all did so for very specific reasons of self-interest. Informants' perceptions of the nature of the trial, of the drugs subject to trial, and of their own involvement were all highly influential in their decision-making. Informants either perceived the trial as potentially beneficial or unlikely to be harmful, and so agreed to participate; or as potentially harmful or unlikely to be beneficial and so declined to participate. CONCLUSION: Most patients applied 'weak altruism', while maintaining self-interest. An emphasis on the safety and equivalence of treatments allowed some patients to be indifferent to the question of involvement. There was evidence that some participants were subject to 'therapeutic misconceptions'. The findings highlight the individual nature of trials but nonetheless raise some generic issues in relation to their design and conduct.

Journal Article↗
PubMed2001

[Scientific production about death and dying themes in a periodical].

The analysis of the production of scientific knowledge has been drawing the attention of many authors in several fields of study. The observation of this tendency consolidated my interest in embarking upon scientific knowledge by analyzing the material published by "OMEGA--Journal of Death and Dying", an American periodical journal that specifically refers to published matter connected with the themes of death and dying. With this objective, I analysed the production that this journal provided from 1980 to 1994, totalizing 526 articles. To the analysis characteristics of the authors and co-authors were considered, themes discussed, and the methods used, including the main methodological tools. Results enable us to discern the tendencies of thematic approach as well as how they are combined and the possibilities of a methodological approach.

Attitude to Death↗
PubMed2006

Complementary therapy use by patients and parents of children with asthma and the implications for NHS care: a qualitative study.

BACKGROUND: Patients are increasingly using complementary therapies, often for chronic conditions. Asthma is the most common chronic condition in the UK. Previous research indicates that some asthma patients experience gaps in their NHS care. However, little attention has been given to how and why patients and parents of children with asthma use complementary therapies and the implications for NHS care. METHODS: Qualitative study, comprising 50 semi-structured interviews with a purposeful sample of 22 adults and 28 children with asthma (plus a parent), recruited from a range of NHS and non-NHS settings in Bristol, England. Data analysis was thematic, drawing on the principles of constant comparison. RESULTS: A range of complementary therapies were being used for asthma, most commonly Buteyko breathing and homeopathy. Most use took place outside of the NHS, comprising either self-treatment or consultation with private complementary therapists. Complementary therapies were usually used alongside not instead of conventional asthma treatment. A spectrum of complementary therapy users emerged, including "committed", "pragmatic" and "last resort" users. Motivating factors for complementary therapy use included concerns about conventional NHS care ("push factors") and attractive aspects of complementary therapies ("pull factors"). While participants were often uncertain whether therapies had directly helped their asthma, breathing techniques such as the Buteyko Method were most notably reported to enhance symptom control and enable reduction in medication. Across the range of therapies, the process of seeking and using complementary therapies seemed to help patients in two broad ways: it empowered them to take greater personal control over their condition rather than feel dependant on medication, and enabled exploration of a broader range of possible causes of their asthma than commonly discussed within NHS settings. CONCLUSION: Complementary therapy use reflects patients' and parents' underlying desire for greater self-care and need of opportunities to address some of their concerns regarding NHS asthma care. Self-management of chronic conditions is increasingly promoted within the NHS but with little attention to complementary therapy use as one strategy being used by patients and parents. With their desire for self-help, complementary therapy users are in many ways adopting the healthcare personas that current policies aim to encourage.

Adult↗
PubMed2005

Exploring factors influencing osteoporosis prevention and control: a qualitative study of Iranian men and women in Australia.

OBJECTIVE: To explore the understanding of osteoporosis risk factors and barriers that influence osteoporosis prevention and control in order to better inform the development of culturally appropriate osteoporosis preventive strategies. METHODS: This qualitative study was based on data collected from 5 focus groups, 10 individual interviews and 3 opportunistic group discussions of Iranian men and women living in Australia. A thematic analysis approach was used and data were managed with a computer-assisted program. Data were collected over 1 year in community settings chosen by participants. RESULTS: The participants had insufficient understanding of osteoporosis risk factors and its implications for their health as they age. There were minor misconceptions about the causes of the disease and how it could be prevented and controlled. Many participants confused osteoporosis and osteoarthritis. Where they did indicate some knowledge of preventive actions, they perceived many obstacles to their undertaking preventive behaviours. CONCLUSIONS: These data suggest that factors adversely influencing osteoporosis prevention and control have their root in misconceptions about osteoporosis and its risk factors, and psychosocial and structural barriers to taking preventive actions. These findings provide insights into barriers that need to be overcome if preventive strategies and intervention programs can be developed to reduce the overall burden of osteoporosis in the community.

Adult↗
PubMed2003

Nursing morale: what is it like and why?

BACKGROUND: There has been increased concern in the United Kingdom about the problems of recruitment and retention in the nursing profession, and how this is influenced by low morale. Despite this, however, there are relatively few studies, particularly of a qualitative nature, where nurses are asked about their morale and what factors affect it. AIMS: The present study aimed to explore nursing morale and determine the factors which nurses believed to influence it. By doing so, it was hoped that factors which affect nurse recruitment and retention could be identified. METHODS: Fifty-eight nurses (28 males, 30 females) working in the National Health Service in Scotland were interviewed in depth about their morale and their concerns about their career. Thematic analysis was carried out and a number of main issues emerged. FINDINGS: Morale in this group was very low. A large number of nurses were considering leaving the profession and the majority would discourage others from becoming a nurse. The themes that emerged, which related to their disillusionment, included low pay, lack of support for education, limited opportunity for promotion, lack of resources and job insecurity. CONCLUSIONS: The findings suggest that while recent salary increases may have helped to improve morale, other factors must also be addressed if further decline in morale and a subsequent nursing shortage is to be avoided.

Adult↗
PubMed2003

Using social constructionist thinking in training social workers living and working under threat of political violence.

This article describes and analyzes an intervention program with social workers living and working in a situation of uncertainty created by political violence such as war and terrorism. The author used a social constructionist perspective as a theoretical framework, emphasizing the effect of the social and political context in constructing the experience and a recognition of the personal and professional knowledge acquired in the daily experience. The author used qualitative methods to evaluate the process and outcome. The narrative-holistic analysis focused on reconstructing meaning and adapting it to the new situation, the main thrust of the program. From the thematic analysis four main themes emerged: (1) loss as a result of political violence; (2) meaning of strength and weakness in situations of political violence; (3) preparation for terrorist attacks; and (4) definition of a safe place. The outcome evaluation describes the meaning of this kind of training program to the participants. The specific context of the training program is discussed as well as possibilities of using it in different contexts.

Allied Health Personnel↗
PubMed2005

[Conceptions and practices of community health agents caring for the elderly].

OBJECTIVE: To assess the main conceptions related to the aging process among community health agents. METHODS: An exploratory descriptive qualitative study was carried out in Pernambuco, Northeastern Brazil, from 2000 to 2002. Data was collected from records and interviews with 148 community health agents. The thematic analysis allowed data classification and assembling. RESULTS: The results show that community health agents identified their main tasks as the development of activities in health education and performance of basic actions. Most of them had negative opinions on the aging process, and complete understanding of the concept of health. They mentioned that most complaints by the elderly are health-related problems and need for affection. Community agents identified caring for the elderly as their main responsibility and inadequate service organization made it difficult to operationalize care delivery. Regarding their expectations, they were found to want to further their knowledge on the aging process. CONCLUSIONS: Community health agents identified themselves as main actors for delivery basic care and core agents in the accomplishment of specific health policies. Their conceptions had a positive perspective in relation to their attributions and aging health. The study points out to the need of promoting agents' training to make them able to deal with the multiple aspects of aging.

Adult↗